title: Role of fibroscan and APRI in detection of liver fibrosis: a systematic review and meta-analysis.
abstract: OBJECTIVE
  Fibroscan and APRI are promising noninvasive alternatives to liver biopsy for detecting hepatic fibrosis. However, their overall test performance in various settings remains questionable. The aim of our study was to perform a systematic review and meta-analysis of diagnostic accuracy studies comparing fibroscan and APRI with liver biopsy for hepatic fibrosis.
  
  
  METHODS
  Electronic and manual bibliographic searches to identify potential studies were performed. Selection of studies was based on reported accuracy of fibroscan and APRI compared with liver biopsy. Data extraction was performed independently by two reviewers. Meta-analysis combined the sensitivities, specificities, and likelihood ratios of individual studies. Extent and reasons for heterogeneity were assessed.
  
  
  RESULTS
  23 studies for fibroscan and 20 studies for APRI in full publication were identified. For patients with stage IV fibrosis (cirrhosis), the pooled estimates for sensitivity of fibroscan were 83.4% (95% confidence interval [CI], 71.7-95.0%) and specificity 92.4% (95% CI, 85.6-99.2%). For patients with stage IV fibrosis (cirrhosis), the pooled estimates for sensitivity of APRI at cutoff point of 1.5 were 66.5% (95% CI, 25.0-100%) and specificity 71.7% (95% CI, 35.0-100%). Diagnostic threshold bias was identified as an important cause of heterogeneity for pooled results in both patient groups.
  
  
  CONCLUSIONS
  Fibroscan and APRI appear to be clinically useful tests for detecting cirrhosis however not useful tools in early stages of fibrosis.
authors.affiliation: Endemic Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt. walfou2000@gmail.com
authors.forename: Ayman Yosry
authors.initials: AY
authors.lastname: Abd El Rihim
authors.forename: Rabab Fouad
authors.initials: RF
authors.lastname: Omar
authors.forename: Waleed
authors.initials: W
authors.lastname: Fathalah
authors.forename: Inas
authors.initials: I
authors.lastname: El Attar
authors.forename: Hanan Abdel
authors.initials: HA
authors.lastname: Hafez
authors.forename: Wesam
authors.initials: W
authors.lastname: Ibrahim
mesh_terms: D001219:Aspartate Aminotransferases / Q000097:blood*; D001707:Biopsy, Needle; D054459:Elasticity Imaging Techniques; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging / Q000473:pathology; D008103:Liver Cirrhosis / Q000175:diagnosis* / Q000000981:diagnostic imaging; D010976:Platelet Count; D012673:Semustine
chemical_list: D012673:Semustine; D001219:Aspartate Aminotransferases